Increased shedding of hair is the most common clinical sign of telogen effluvium. Hair scalp would feel less dense than it was before. Hair loss does not follow a distinct pattern and affects the entire region of scalp equally.
In the acute form of telogen effluvium, hair loss occurs for less than 6 months. Affected individuals notice sudden loss of hair. In the chronic form, hair loss continues for more than 6 months. The onset is gradual, but it can get difficult to identify the inciting factors .
Laboratory tests are of little help in diagnosing the condition of telogen effluvium. In view of this, scalp biopsy is the one of the most useful methods to diagnose the condition. However, this test is also seldom necessary if history of the disease is characteristic and gentle pull produces numerous hairs. For the pull test approximately 20 to 60 hairs are firmly, but not forcefully, tugged away from the scalp. Telogen hairs will have a characteristic appearance .
In addition, blood tests would also be required to determine the underlying etiology. Complete blood profile, serum iron, ferritin and iron saturation are all warranted to evaluate the presence of iron deficiency. Medical practitioners regard iron saturation as a more valuable test for confirming iron deficiency .
Treating the underlying etiology can help in effective management of the condition. Individuals with a poor diet are advised to consume a nutritionally balanced diet in order to correct deficiencies if any. If telogen effluvium occurs as a side effect of certain medications, then the same should be withdrawn and substitute advised .
Chronic telogen effluvium does not resolve spontaneously and can lead to baldness in certain cases. Individuals are given topical minoxidil which has proven to be helpful in many instances. Affected individuals often chose hair transplantation for restoring the lost hair; its efficacy has however not been proved.
A well balanced diet should be consumed. Those in practice of taking large doses of Vitamin A should be discontinued.
Factors that significantly disrupt the normal hair cycle call for development of telogen effluvium. Some form of stress forcibly causes the roots of hair to enter the telogen phase prematurely. The various factors responsible include several eating disorders, hormonal imbalances, surgery, and physical trauma, deficiency of iron, certain medications, weight loss and changes in dietary pattern. Other factors that contribute to more than normal hair loss include, severe infections, conditions of hypothyroidism and hyperthyroidism, high fever and psychological stress .
Telogen effluvium is a common phenomenon, and majority of individuals have experienced it, at least once in their lifetime. The exact incidence however is not known. No mortality has been associated with telogen effluvium. Morbidity profile is limited only to mild cosmetic alterations. The condition can strike any individual at any age. Infants are at lesser risk for developing telogen effluvium. Telogen effluvium has a predilection for women between the age group of 30 to 60 years .
Telogen effluvium causes significant loss of hair from all parts of the body, however hair loss from the scalp is the more evident. Pathophysiology of telogen effluvium is greatly influenced by the hair growth cycle. The hair cycle follows distinct phases:
Anagen occurs for for 2 to 7 years and is genetically determined. The catagen phase is short and signals the end of the active growth of a hair. The resting phase takes between 1 to 6 months. During the telogen, the hair continues to remain in the follicle, until it is removed by growth of new hair . In majority of individuals, 5 – 15% of scalp hair is always in the telogen phase. Trigger factors such as stress, physical trauma, medications and or surgery can cause the hair to prematurely enter the telogen phase. Shedding however does not occur until new hair grows in the follicle .
Telogen phase is defined as the resting stage of the hair follicles. Alterations in the normal cycle of the hair can lead to considerable hair loss. Telogen effluvium can be both acute and chronic in nature. It is more of a reactive process which is triggered by hormonal factors or conditions that induce psychological stress. With prompt initiation of treatment and if the disease is in its initial stages, recovery is spontaneous. If there is a family history of alopecia, then complete recovery may take time .